Exposure to prescription opioid analgesics in utero and risk of neonatal abstinence syndrome: population based cohort study

Abstract

ObjeCtiveTo provide absolute and relative risk estimates of neonatal abstinence syndrome (NAS) based on duration and timing of prescription opioid use during pregnancy in the presence or absence of additional NAS risk factors of history of opioid misuse or dependence, misuse of other substances, non-opioid psychotropic drug use, and smoking.Design Observational cohort study.setting Medicaid data from 46 US states. PartiCiPantsPregnant women filling at least one prescription for an opioid analgesic at any time during pregnancy for whom opioid exposure characteristics including duration of therapy: short term (<30 days) or long term (≥30 days); timing of use: early use (only in the first two trimesters) or late use (extending into the third trimester); and cumulative dose (in morphine equivalent milligrams) were assessed.

Opioid use during pregnancy: a population-based cohort study

“…Considering that opioids have been associated with neural tube defects, cardiac septal defects and the rise in neonatal hospital admissions associated with neonatal abstinence syndrome, our findings raise some concern. [9][10][11][12][13][14] A previous analysis of the overall Canadian population, for the period 2005-2010, showed a similar increase in opioid use of 13.1%. 29 US database studies have also shown increases in opioid use during pregnancy (from the mid-1990s to 2009), but the magnitude of change was generally larger than what we found, with increases in exposure ranging from 0.23-fold to 4.73-fold.…”

“…11,12 Recent studies of opioid exposure in pregnancy have reported incidences of 4.3 to 5.9 cases of neonatal abstinence syndrome per 1000 births. 13,14 Considering the overall population use of opioids in North America and the potential harms of opioid exposure during pregnancy to the developing fetus and the neonate, it is important to study prescribing patterns in order to understand the potential implications from a public health perspective. Two large retrospective analyses of outcomes related to antenatal and postpartum opioid use have been performed in Ontario, Canada, in addition to small cohort studies evaluating the incidence of narcotic abuse during pregnancy in communities in northwestern Ontario.…”

Dental Drug Safety during Pregnancy

“…Oxycodone (Percocet) can be used with relative safety and is a category B. Hydrocodone (Norco, category C) has exhibited increase risk to fetal respiratory depression at high maternal dosages. Furthermore, use of hydrocodone during the early stages of pregnancy lead to various birth defects [21]. All opioids should be used with discretion and close consultation with the patients' health care providers due to the high risk of fetal physical dependence at birth.…”

Commentary on Gibson et al. (2017): Gestational age and the severity of neonatal abstinence syndrome

“…In a large cohort (n = 102) of late preterm infants (gestational ages 34-36 weeks), the likelihood of receiving pharmacological treatment for NAS was not different compared to babies born at later gestations. These data are of particular interest in light of recent rises not only in the number of illicit opioid using mothers, but also in mothers on prescribed opioids, and indicate that concerns regarding the development of NAS following maternal opioid use in pregnancy should not influence timing of delivery [4,5].Although initiation of opioid replacement therapy was not influenced by gestation, median duration of treatment for late preterm infants was significantly shorter (by approximately 30%) compared to infants born at term. The authors postulate that this may be due to differences in placental opioid transport related either to gestation or concomitant illicit drug use, reduced cumulative opioid exposure, slower postnatal opioid excretion, neurological immaturity or a combination of factors [1,6].…”

“…In a large cohort (n = 102) of late preterm infants (gestational ages 34-36 weeks), the likelihood of receiving pharmacological treatment for NAS was not different compared to babies born at later gestations. These data are of particular interest in light of recent rises not only in the number of illicit opioid using mothers, but also in mothers on prescribed opioids, and indicate that concerns regarding the development of NAS following maternal opioid use in pregnancy should not influence timing of delivery [4,5].…”